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Plan A Forms
The following forms are available under Health and Welfare Plan A.
Caremark Mail Order Form
Caremark Reimbursement Form
Annual Physical and Hearing Aid Claim Form
Appointment of Personal Representative
Blue Cross Health Insurance Claim Form
Dental Claim Form
Designation of Beneficiary
MetLife - Weekly Accident and Sickness Benefits Claim Form
Davis Vision Out of Network Claim Form
MetLife - Participant Life Insurance Form
The Funds
Plan A
Summary Plan Description
Summary of Benefits and Coverage
Plan A Features
Plan A Rates
Plan A Forms
Plan C
Summary Plan Description
Summary of Benefits and Coverage
Benefits at a Glance
CAPP Quarterly Rates
MRP Guidebook
Plan C Forms
Retiree-MRP
Summary Plan Description
RMRP Guidebook
COBRA
Cobra Rates
COBRA - Disability Rates
NYS COBRA Subsidy Application
Forms/Documents
Trustees
Annuity Fund
Summary Plan Description
Link to Wells Fargo
Forms/Documents
Trustees
Plan B
Summary Plan Description
Plan C
Summary Plan Description
Forms/Documents
Trustees
Participant Quick Links
My Dashboard
My Work History
Applications/ Forms/ Documents
Employer Login
Local Login
Life Events Toolkit
Moving
Marriage
Divorce
Birth of a Child
Beneficiary Information
Dependent Information
Contact Information